6 Things to Know About Obamacare

I hate the word “Obamacare.” Last year, television host Jimmy Kimmel took to the streets to ask passersby which they liked better, Obamacare or the Affordable Care Act (ACA). They’re one and the same, of course, but the ACA turned out to be much more popular than Obamacare, especially when it was broken down into specifics. It would be easy to dismiss the Kimmel bit as a stunt for the sake of a few laughs, but it’s more disturbing than it is funny because that mindset is everywhere.

The Affordable Care Act is far from perfect and the initial rollout of the marketplace exchanges left much to be desired. Still, I wish that people would delve deeper than the political talking points to get the facts. I have no problem with people who don’t like the ACA when their dislike is based on fact. But since its rollout, I’ve had far too many discussions with people who hate Obamacare simply because it is Obamacare. Some base it on what they’ve heard. Others base it on personal experience — they’ve had to change their policy, have been shifted into a policy they dislike, or their premiums have risen.

My gripe? People who complain about the ACA, but refuse to visit healthcare.gov to shop around for other options or to learn for themselves if what they’ve been told is true. Obamacare cooties and all that. Hate the ACA if you will, but if you don’t do your homework, you may be cutting off your nose to spite your face. Here’s why.

1. There’s no insurance called Obamacare. You won’t get an insurance card with the president’s picture on it, nor is it a political endorsement. The marketplace exchanges provide a way for consumers to shop for insurance. You can compare policies from a variety of insurers. There are different levels of plans — catastrophic, bronze, silver, gold, and platinum. These plans vary in cost and coverage. There are HMOs (health maintenance organization), PPOs (preferred provider organizations), EPOs (exclusive provider organizations), and POS (point of service) plans. Inside the exchange or outside the exchange, it’s still health insurance.

2. If you don’t need or qualify for a subsidy, there’s no need to fill out financial information on healthcare.gov. Just go shopping. For those of us who were faltering in the individual insurance market due to pre-existing conditions (that is, we’ve actually needed health care, not that we’re deadbeats) prior to the ACA, the marketplaces have opened up a whole new world of options. No more exclusions. No more yearly or lifetime limits. No more arbitrary cancellations.

3. You still shop the exchanges outside of open enrollment if you have a qualifying event such as getting married, divorced, losing your job, or moving across state lines. If you simply want to change policies, the next open enrollment is November 15, 2014 – February 15, 2015.

4. Prices vary from state to state and premiums will likely rise. Premiums have always risen. For those of us in the individual market prior to the ACA, a 30 percent rate hike from one year to the next was not unusual. Neither was it unusual to charge women higher premiums than men, but that’s no longer allowed. Because of the new law, insurers must spend at least 80-85 percent of health policy premiums on medical care. If they don’t, the money will be refunded to you.

5. It costs nothing to window shop on healthcare.gov. If your insurance agent insists that you need to buy a particular policy and steers you outside of the exchange, do your homework. Find out what’s available and how much it costs. All the rules, patient protections, and essential benefits are listed there, so you don’t have to take anyone else’s word for it. In the end, you’ll be able to make an educated decision about which policy is best for you, on or off the exchange.

6. You can purchase your plan through the exchange, but when it comes to visiting your doctor, putting in a claim, or checking your EOBs (explanation of benefits) and year-to-date deductibles, you’ll deal directly with doctors, medical facilities, and your insurer — same as if you purchased it outside the exchange.

Some states have set up their own exchanges while others chose to rely on the federal exchange. Some states accepted federal help in expanding Medicaid and others chose to refuse it. Those are local issues, so some states have better options than others. No matter where you live, the rumor mill is working overtime, so it’s worth a little research time.

Personally, I’d prefer a single-payer system, but I’m grateful for the ACA. Thanks to the new law, I have a good health insurance policy. And next open enrollment, I can shop around for a different one if I so choose. That’s a new benefit for people like me.

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91 comments

Also everybody seems to equate health "insurance" with health "care." They are NOT one and the same. Just because you have health insurance doesn't mean you have health CARE. There are very few providers in our area who will accept any of the plans my husband's employer provides. How is that having health CARE if the local physicians don't accept the insurance? Yes, he has insurance but still very little access to care. Huge difference.

Unfortunately in our case, there is nothing affordable about the "Affordable" Care Act. My husband's company pays for a significant portion of his insurance and because the percentage of his income so low, we aren't eligible for any subsidies. It costs a significant percentage of his take-home pay just to add me, which is NOT affordable. The subsidies are only for those who meet the income guidelines they only count what the EMPLOYEE pays for their own insurance - not what it costs to add family members. It doesn't matter if you have to pay $1200 to add your family but it only costs you $30 a month for your insurance. They only look at the $30 you have to pay in relation to your income, even if your income is low enough that it doesn't begin to cover the costs of adding your family. You still get fined.

In our case, the high premiums to add me are for the cheaper plans as far as premium costs go with a super high deductible. The plan forces you to pay out of pocket for EVERYTHING until that deductible is met, which it wouldn't be unless we're hospitalized. So we'd be paying all that money every month and still can't afford to go to the doctor.

I've shopped around on the exchange and there are no plans available that I can afford there either. So I get to be fined for "refusing" to get health insurance, but we just can't afford it.

Also everybody seems to equate health "insurance" with health "care." They are NOT one and the same. Just because you ha

So glad I lived in Europe for six years, so I had a chance to see a different model than the American one. I didn't switch to the ACA insurance network because my Anthem insurance was a bit cheaper. Now, an orthopedic surgeon is telling me I need an MRI, and Anthem has denied it. It will take at least 45 days for an appeal to be processed. Meanwhile I limp around with sciatica.

That's because nowadays people go for any reason. In France, when we feel bad, we go to the pharmacists first. They are well qualified and can give helpful advice. We only go to the doctor for check ups and real issues. Noone goes to A&E for a small cut, but I have seen this happen in England.
Also the government has cut down the amount of nurses, but hopefully the next government will return to having much needed staff such as nurses, police and teachers.

I agree with Florence, but the National Health Service is severly struggling with the numbers, and has been for years. So, whilst free is a good idea, too many people using it for minor issues, are causing a huge headache for the industry.